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Expiratory rib cage Compression in mechanically ventilated subjects: a randomized crossover trial [corrected]
Fernando S Guimarães1, Agnaldo J Lopes, Sandra S Constantino
1Rehabilitation Sciences Master's Program, Augusto Motta University Center, Rio de Janeiro, Brazil.
Respiratory Care
|October 10, 2013
Summary
Expiratory rib cage compression (ERCC) improved expiratory flow and cleared more secretions in ventilated patients. However, it did not significantly improve respiratory mechanics or sputum production for clinical relevance.
Area of Science:
- Respiratory Physiology
- Mechanical Ventilation
- Pulmonary Rehabilitation
Background:
- Expiratory rib cage compression (ERCC) is empirically used to enhance expiratory flows and airway clearance in mechanically ventilated patients.
- This study investigates the acute effects of ERCC on mechanical parameters and sputum clearance in patients with pulmonary infections.
Purpose of the Study:
- To evaluate the acute mechanical effects of an ERCC protocol.
- To assess the impact of ERCC on sputum clearance in mechanically ventilated patients.
Main Methods:
- A randomized crossover study involving 20 mechanically ventilated subjects.
- Comparison of ERCC intervention (compression followed by hyperinflation) versus a control intervention (normal ventilation).
- Measurement of respiratory mechanics (compliance, resistance) and expiratory flows (PEF, flow 30% VT) at various time points.
Main Results:
- ERCC cleared 34.4% more secretions compared to the control group.
- No significant differences in respiratory mechanics (Cst, Ceff, Rtot, Rinit) were observed immediately post-intervention.
- ERCC led to increased static and effective compliance post-hyperinflation and significantly increased peak expiratory flow and flow at 30% tidal volume.
- Expiratory flow limitation (EFL) occurred in 30% of subjects during ERCC.
- Effect sizes for secretion volume, Cst, and Ceff were small.
Conclusions:
- ERCC enhances expiratory flow but lacks clinically significant benefits for sputum production and respiratory mechanics in hypersecretive ventilated patients.
- The ERCC maneuver carries a risk of inducing expiratory flow limitation in some patients.
- Further research may be needed to optimize ERCC protocols or identify specific patient subgroups who might benefit.
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